The broad, long-term objective of this proposal a health care delivery system with the following characteristics: (1) a focus on imaging that facilitates an objectified, evidence-based practice of medicine, (2) the ability to tailor an appropriate imaging protocol to tailor an appropriate imaging protocol for an individual patient, and (3) transform teleradiology to an infrastructure that runs on a variety of hardware platforms. The proposal specifically aims to objectify a patient's subjective clinical presentation by defining individually tailored imaging work-up sequences based on input from specialists and structured patient data, develop methods for automated data collection to facilitate health services research related to the process, outcomes, and resource utilization, develop algorithms to correlate patient data with medical literature, design a modular system that enables hardware independence and implement and evaluate a prototype with a well-defined patient population. The project's facilitation of evidence-based practice of medicine should reduce medical uncertainties and improve quality of care. Research design and methods include: (1) structured data input, teleconsultation, and supervised machine learning for individually tailored imaging protocols; (2) a flexible input architecture and data representation for health services data collection; (3) feature extraction, pattern discovery, and content-based indexing techniques, for content correlations; and (4) a network-centric architecture which use TCP/IP, JAVA, and CORBA standards for hardware independence. Development of the proposed infrastructure will promote evidence-based practice of medicine, improve the process and outcome of care, and facilitate cost-effectiveness studies by providing more accurate health services research data.